{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,25]],"date-time":"2026-02-25T06:26:08Z","timestamp":1772000768450,"version":"3.50.1"},"reference-count":43,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,2,25]],"date-time":"2026-02-25T00:00:00Z","timestamp":1771977600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100004166","name":"Medical University of Warsaw","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100004166","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Med."],"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>One-year outcomes after kidney transplantation (KTx) have improved markedly; however, ultra-long graft survival remains rare. We analyzed an outcome-defined sample from a single-center, single-era cohort to identify early, potentially modifiable factors associated with \u226525-year graft survival and to translate these associations into pragmatic, hypothesis-generating, center-level process targets.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      We retrospectively reviewed the first adult solitary KTx performed in 1980\u20131995. Two outcome-defined, unmatched groups were compared: ultra-long survivors (ULS; graft survival \u226525\u202fyears;\n                      <jats:italic>n<\/jats:italic>\n                      \u202f=\u202f59) and early graft failure (EGF; \u226410\u202fyears;\n                      <jats:italic>n<\/jats:italic>\n                      \u202f=\u202f61). We extracted pre- and peri-transplant variables, first-year rejection burden (0\/1\/\u22652 treatment cycles), and longitudinal laboratory data. Unconditional logistic regression was used to estimate adjusted associations (odds ratios [ORs]) in a complete-case subset with a pre-specified, parsimonious adjustment (recipient and donor age).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Cold ischemia time (CIT) was shorter in ULS than in EGF (1281.8\u202f\u00b1\u202f473.9 vs. 1764.8\u202f\u00b1\u202f564.9\u202fmin;\n                      <jats:italic>p<\/jats:italic>\n                      \u202f=\u202f0.016; mean difference 483\u202fmin) and was associated with higher odds of EGF (per 60 min, adjusted OR 1.29; 95% confidence interval (CI) 1.02\u20131.63;\n                      <jats:italic>p<\/jats:italic>\n                      \u202f=\u202f0.032). ULS had a lower first-year rejection-treatment burden (\u22651 antirejection treatment cycle, 40.7% vs. 63.9%;\n                      <jats:italic>p<\/jats:italic>\n                      \u202f=\u202f0.017). Early kidney function profiles favored ULS (lower creatinine at 6\u202fmonths, 1\u202fyear, and 5\u202fyears; all\n                      <jats:italic>p<\/jats:italic>\n                      \u202f\u2264\u202f0.004; higher hemoglobin at 5\u202fyears;\n                      <jats:italic>p<\/jats:italic>\n                      \u202f&amp;lt;\u202f0.001). Exploratory time-to-event analyses showed concordant directions for CIT and rejection-treatment burden. In an exploratory univariable landmark analysis, 6-month creatinine levels showed moderate within-sample discrimination for EGF versus ULS (apparent area under the curve [AUC], 0.739)\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Discussion<\/jats:title>\n                    <jats:p>Overall, CIT showed the most consistent and potentially actionable association with long-term outcomes in this historical cohort; however, inferences are observational, and residual confounding cannot be excluded.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fmed.2026.1745986","type":"journal-article","created":{"date-parts":[[2026,2,25]],"date-time":"2026-02-25T05:32:49Z","timestamp":1771997569000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Factors associated with 25-year kidney allograft survival: a single-center retrospective analysis"],"prefix":"10.3389","volume":"13","author":[{"given":"Anna","family":"Anyszek","sequence":"first","affiliation":[{"name":"Department of Nephrology Nursing, Medical University of Warsaw","place":["Warsaw, Poland"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"\u0141ukasz","family":"Czy\u017cewski","sequence":"additional","affiliation":[{"name":"Department of Geriatric Nursing, Medical University of Warsaw","place":["Warsaw, Poland"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Magdalena","family":"Durlik","sequence":"additional","affiliation":[{"name":"Department of Transplantation Medicine, Nephrology and Internal Diseases, Medical University of Warsaw","place":["Warsaw, Poland"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Janusz","family":"Wyzga\u0142","sequence":"additional","affiliation":[{"name":"Department of Nephrology Nursing, Medical University of Warsaw","place":["Warsaw, Poland"]}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2026,2,25]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"473","DOI":"10.1038\/s41581-024-00820-6","article-title":"Chronic kidney disease and the global public health agenda: an international consensus","volume":"20","author":"Francis","year":"2024","journal-title":"Nat Rev Nephrol"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"54","DOI":"10.3390\/jcm14010054","article-title":"The clinical and economic burden of chronic kidney disease in Poland: inside patient-level microsimulation modelling of CKD","volume":"14","author":"Masajtis-Zagajewska","year":"2025","journal-title":"J Clin Med"},{"key":"ref3","first-page":"340","article-title":"Podstawowe wiadomo\u015bci na temat przewlek\u0142ej choroby nerek","volume-title":"Nefrologia. 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transplantation in the era of modern immunosuppression?","volume":"33","author":"Moreso","year":"2013","journal-title":"Nefrol"},{"key":"ref21","first-page":"1","article-title":"Long term outcomes of kidney transplant: characteristics of recipients with 20 or more years of graft survival","volume":"109","author":"La Manna","year":"2016","journal-title":"J Med Surg Pathol"},{"key":"ref22","doi-asserted-by":"publisher","first-page":"243","DOI":"10.2298\/VSP190313091V","article-title":"Graft and patient survival after renal transplantation in the period from 1996-2017 in military medical academy, Belgrade, Serbia","volume":"79","author":"Vavi\u0107","year":"2022","journal-title":"Vojnosanit Pregl"},{"key":"ref23","doi-asserted-by":"publisher","first-page":"450","DOI":"10.1111\/j.1600-6143.2010.03283.x","article-title":"Long-term renal allograft survival in the United States: a critical reappraisal","volume":"11","author":"Lamb","year":"2011","journal-title":"Am J 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trials","volume":"533","author":"Fitzsimmons","year":"2002","journal-title":"Am J Transplant"}],"container-title":["Frontiers in Medicine"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2026.1745986\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,2,25]],"date-time":"2026-02-25T05:32:51Z","timestamp":1771997571000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2026.1745986\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,2,25]]},"references-count":43,"alternative-id":["10.3389\/fmed.2026.1745986"],"URL":"https:\/\/doi.org\/10.3389\/fmed.2026.1745986","relation":{},"ISSN":["2296-858X"],"issn-type":[{"value":"2296-858X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,2,25]]},"article-number":"1745986"}}